Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Statewide
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 31814 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.577778 $21.3800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 271 303 513.674072 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 19 20 104.805556 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 2.688888 $99.4900 $37.0000
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Subtotal (Total Children Is Unduplicated) 297 332 621.746294 $120.8600 $0.1900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 196 260 154.971210 $7516.1800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.646499 $30.4400 $47.0900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 96 99 45.644441 $876.3700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $7.7600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.068493 $1.5000 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.666666 $108.5600 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 28 29 12.537290 $320.0700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $46.8000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.015221 $121.4200 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.866667 $358.3400 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 39 46 61.108453 $3055.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 402 438 481.518924 $24075.9300 $50.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.355556 $19.7400 $55.5100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 4.038812 $302.9100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 21 8.350000 $626.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 2.138812 $160.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 32 32 13.366665 $741.8400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 12.853423 $964.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 7.747162 $581.0500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 0.021916 $1.6500 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 13.219765 $733.7000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 10.455709 $784.1800 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 14.142857 $707.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 10 10 6.844444 $349.4100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 71 79 58.818408 $3002.6900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 16 17 19.059601 $972.9900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 51 56 36.401120 $1858.2800 $51.0500
SCREEN-T1023 SCREENING 9 9 3.105327 $155.2700 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.087671 $4.4800 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 95 104 115.938617 $5918.6900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 8 8 8.160318 $416.5800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 1.688889 $84.4500 $50.0000
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Subtotal (Total Children Is Unduplicated) 1019 1299 1100.583380 $54904.5300 $49.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 49 66 34.300838 $171505.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 5.227777 $261.3900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 111 116 612.986309 $30649.3000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 6.582540 $471.3700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 7 8 2.468265 $590.4200 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 951 1205 1147.162228 $57358.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 55 68 101.757904 $2543.9600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3807 6033 9885.010300 $494250.7600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 226 305 1175.019040 $29375.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 898 1142 1873.596122 $93679.8500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 42 47 92.911110 $2322.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 822 994 1582.566685 $79128.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 24 50.307937 $1257.7000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2325 2776 3909.033790 $195451.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 133 153 616.404782 $15410.1500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.416667 $323.8300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 34 289.780952 $7244.5300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 242.857142 $12142.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 17 27 126.045239 $6302.2700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 434 539 3789.718241 $189486.0700 $50.0000
INTR -T1013 INTERPRETER 178 232 1299.411805 $64970.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5960 11468 65043.913901 $650439.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 189 222 1704.688885 $121783.0300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 24 26 159.664285 $9132.7900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 215 246 1757.235327 $125536.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 25 28 229.014285 $13090.4800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 3.192390 $207.5100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.015221 $240.7200 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
3 4 0.594521 $140.9700 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 4 4 2.738889 $1298.9000 $474.2400
SENS -V5264 EARMOLD 6 6 8.199998 $147.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 395 465 3311.748371 $236591.4800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 13.476190 $770.8400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 132.999999 $1846.0400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 2002 3903 390720.639438 $173870.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 9406 30183 489945.579437 $2789828.6500 $5.6900
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Total 31814 491667.909111 $2844854.0400 $5.7900
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Number of Children (Unduplicated) With at Least One Authorization 9712